18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: Adding value to clinical staging

Elizabeth H. Dibble, Ana C Lara Alvarez, Minh Tam Truong, Gustavo Mercier, Earl F. Cook, Rathan M. Subramaniam

Research output: Contribution to journalArticle

Abstract

18F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). Methods: The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant singleinstitution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV. mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. Results: In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P = 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P = 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (x 2 value change, 1.16-6.71; P = 0.01) and when TGA was added to AJCC stage in model II (x 2 value change, 1.16-4.37; P = 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P = 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P = 0.08), though the result was not statistically significant. Conclusion: Gradient-based segmentations of primary tumor MTV and TGA are potential 18F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.

Original languageEnglish (US)
Pages (from-to)709-715
Number of pages7
JournalJournal of Nuclear Medicine
Volume53
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Oropharyngeal Neoplasms
Squamous Cell Neoplasms
Fluorodeoxyglucose F18
Tumor Burden
Mouth
Neoplasms
Survival
Squamous Cell Carcinoma
Confidence Intervals
Health Insurance Portability and Accountability Act
Neoplasm Staging
Research Ethics Committees
Proportional Hazards Models
Disease-Free Survival
Cohort Studies
Multivariate Analysis
Retrospective Studies
Regression Analysis

Keywords

  • Metabolic tumor volume
  • Oral and oropharyngeal SCC
  • Staging
  • Total glycolic activity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer : Adding value to clinical staging. / Dibble, Elizabeth H.; Alvarez, Ana C Lara; Truong, Minh Tam; Mercier, Gustavo; Cook, Earl F.; Subramaniam, Rathan M.

In: Journal of Nuclear Medicine, Vol. 53, No. 5, 05.2012, p. 709-715.

Research output: Contribution to journalArticle

Dibble, Elizabeth H. ; Alvarez, Ana C Lara ; Truong, Minh Tam ; Mercier, Gustavo ; Cook, Earl F. ; Subramaniam, Rathan M. / 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer : Adding value to clinical staging. In: Journal of Nuclear Medicine. 2012 ; Vol. 53, No. 5. pp. 709-715.
@article{24a02c8639db48b887dab3f1becefe37,
title = "18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: Adding value to clinical staging",
abstract = "18F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). Methods: The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant singleinstitution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38{\%}, 50{\%}, and 60{\%} of maximum standardized uptake value (SUV). The TGA is defined as MTV. mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. Results: In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95{\%} confidence interval, 1.01-1.10; P = 0.006) and 1.00 (95{\%} confidence interval, 1.00-1.01; P = 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (x 2 value change, 1.16-6.71; P = 0.01) and when TGA was added to AJCC stage in model II (x 2 value change, 1.16-4.37; P = 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P = 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P = 0.08), though the result was not statistically significant. Conclusion: Gradient-based segmentations of primary tumor MTV and TGA are potential 18F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.",
keywords = "Metabolic tumor volume, Oral and oropharyngeal SCC, Staging, Total glycolic activity",
author = "Dibble, {Elizabeth H.} and Alvarez, {Ana C Lara} and Truong, {Minh Tam} and Gustavo Mercier and Cook, {Earl F.} and Subramaniam, {Rathan M.}",
year = "2012",
month = "5",
doi = "10.2967/jnumed.111.099531",
language = "English (US)",
volume = "53",
pages = "709--715",
journal = "Journal of Nuclear Medicine",
issn = "0161-5505",
publisher = "Society of Nuclear Medicine Inc.",
number = "5",

}

TY - JOUR

T1 - 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer

T2 - Adding value to clinical staging

AU - Dibble, Elizabeth H.

AU - Alvarez, Ana C Lara

AU - Truong, Minh Tam

AU - Mercier, Gustavo

AU - Cook, Earl F.

AU - Subramaniam, Rathan M.

PY - 2012/5

Y1 - 2012/5

N2 - 18F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). Methods: The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant singleinstitution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV. mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. Results: In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P = 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P = 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (x 2 value change, 1.16-6.71; P = 0.01) and when TGA was added to AJCC stage in model II (x 2 value change, 1.16-4.37; P = 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P = 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P = 0.08), though the result was not statistically significant. Conclusion: Gradient-based segmentations of primary tumor MTV and TGA are potential 18F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.

AB - 18F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). Methods: The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant singleinstitution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV. mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. Results: In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P = 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P = 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (x 2 value change, 1.16-6.71; P = 0.01) and when TGA was added to AJCC stage in model II (x 2 value change, 1.16-4.37; P = 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P = 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P = 0.08), though the result was not statistically significant. Conclusion: Gradient-based segmentations of primary tumor MTV and TGA are potential 18F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.

KW - Metabolic tumor volume

KW - Oral and oropharyngeal SCC

KW - Staging

KW - Total glycolic activity

UR - http://www.scopus.com/inward/record.url?scp=84860705942&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860705942&partnerID=8YFLogxK

U2 - 10.2967/jnumed.111.099531

DO - 10.2967/jnumed.111.099531

M3 - Article

C2 - 22492732

AN - SCOPUS:84860705942

VL - 53

SP - 709

EP - 715

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

SN - 0161-5505

IS - 5

ER -